Related Stories

New UK research shows that patients given clear choices about medical treatments are more likely to make decisions they can live with.

Two studies by Elizabeth Murray of University College London and colleagues report on the use of tools called 'decision aids' to help patients understand the choices they face. Their results are published in this week's British Medical Journal.

"When well informed, patients often make different decisions from their physicians," writes Professor Richard Deyo of the University of Washington in an accompanying editorial.

"Many medical decisions fall into a grey area where the optimal choice for an individual patient may be unclear and where reasonable people might choose differently."

The studies by Murray and team looked at patients considering hormone replacement therapy and prostate surgery. In both cases, patients must weigh up risks and benefits.

Men with an enlarged prostate must choose between surgery, drugs, and watchful waiting.

According to Professor Deyo, there is considerable evidence that patients want more information and greater involvement in decisions about such treatments. Doctors, however, don't discuss risks and benefits adequately, or check whether patients fully understand their options.

The 'decision aid' used by Murray and colleagues was an interactive multimedia program, with exercises to help people clarify their own health needs. The material emphasised that different patients reach different decisions.

The researchers compared the decision-making of two groups of patients: one using the decision aid, and one receiving conventional clinical care.

Patients using the aid reached a decision that they remained comfortable with earlier than the group who did not use the aid. And their involvement in decision-making did not make them more anxious, say the researchers.

Professor Deyo describes such 'new generation' decision aids as allowing patients to obtain tailored information on the benefits and risks of alternative approaches based on best available evidence.

"These new aids make choices explicit, rather than implying a preferred course," writes Professor Deyo.

Patients who played a more active role in decison-making made choices that were more in keeping with their personal values, he added.

Many questions remain about the use of decision aids, however, Professor Deyo believes.

"How can we ensure that presentations are objective and balanced, rather than designed to lead patients to a particular conclusion? How will programmes be continuously updated, and who will support this work?", he writes.

"But for now," he concludes, "the revolutionary contribution of these new aids lies simply in making it clear that there often is a choice."